Attend new client implementation meetings with external partners to discuss eligibility requirements and protocols
Recommend eligibility file formats to external partners and coordinate receipt and processing of eligibility data
Acting as a healthcare data subject matter expert on Eligibility guidelines and Electronic Data Interchange (EDI) protocols
Serving as a point of coordination for member eligibility issue identification and issue resolution with internal teams and external partners
Identify and triage eligibility issues and support the resolution of all errors related to transferring, loading, and management of eligibility data
Proactively monitoring system status and eligibility data to quickly identify potential abnormalities that might impact quality and accuracy
Ensuring that all issues and errors are resolved using designated operating standards and within defined service levels
Assist with the validation of eligibility data integrity through regular audits and reconciliation processes
Ensure accurate and timely entry of group/plan structure determinations for benefits and enrollment

Requirements

Bachelor’s degree
1+ years of previous work experience, preferably in PBM, Healthcare, Data Exchange, and Eligibility
Ability to match key PBM concepts and data fields across various systems and file layouts to ensure consistency and accuracy of data transfers
Ability to analyze complex business problems to discover and resolve root causes
Proficiency in SQL, Excel, JSON and other technical data skills preferred
Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders
Self-motivated and detail-oriented problem solver
Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLExcelJSONdata analysisdata integritydata reconciliationdata managementElectronic Data Interchange (EDI)eligibility guidelinesfile formats

Soft Skills

communicationproblem solvingself-motivateddetail-orientedcollaborationability to handle multiple prioritiesrelationship buildingissue resolutionanalytical thinkingproactive monitoring

Certifications

Bachelor’s degree